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Table of Contents
LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 156-157

Cancer care delivery amidst the COVID-19 pandemic: Common challenges and counter measures


1 Department of Radiation Oncology, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
2 Cancer Control and Prevention Division, Indian Society of Clinical Oncology, New Delhi, India

Date of Submission28-Jan-2021
Date of Decision12-Feb-2021
Date of Acceptance21-Feb-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Abhishek Shankar
Department of Radiation Oncology, Lady Hardinge Medical College and SSK Hospital, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_21_21

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How to cite this article:
Shankar A, Saini D. Cancer care delivery amidst the COVID-19 pandemic: Common challenges and counter measures. Cancer Res Stat Treat 2021;4:156-7

How to cite this URL:
Shankar A, Saini D. Cancer care delivery amidst the COVID-19 pandemic: Common challenges and counter measures. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:156-7. Available from: https://www.crstonline.com/text.asp?2021/4/1/156/312069



Every sector of the health-care delivery system has been affected by the novel coronavirus disease 2019 (COVID-19), and the cancer care delivery system was no exception.

There has been a surge of publications from different parts of India highlighting the common challenges and counter measures in cancer care amidst the COVID-19 pandemic. We published the first article from India on cancer care delivery challenges amidst COVID-19 in March, 2020,[1] followed by the article from the Tata Memorial Hospital in Mumbai, India.[2] In these difficult times, perspectives,[3],[4],[5] viewpoints,[6],[7],[8] case reports,[9] and guidelines[10],[11],[12] shared by various institutions and organizations helped us optimize the delivery of cancer care. We read with interest the article by Pandey et al. titled, “Impact of the coronavirus disease-2019 pandemic on cancer care delivery: A single-center retrospective study,”'and congratulate them for one of the first original studies on this important issue.[13]

Pandey et al.'s study is a retrospective audit of cases treated at the Regional Cancer Center in Bihar, India. However, there are several limitations to this study with various biases associated with the retrospective study design. Most of these limitations such as the actual reasons for the drop in the footfalls, the place of residence of the patients, and exclusion of patients receiving oral chemotherapy have already been addressed by Ghosh and Ganguly in their editorial.[14]

Based on our critical analysis of Pandey et al.'s study, we would like to address a few more important points through this correspondence. Although the article title reflects the impact of COVID-19 on cancer care delivery, all the aspects of cancer care have not been discussed. Moreover, the authors have compared the patient footfalls in the prelockdown period with the patient footfalls during the lockdown. However, in our opinion, a comparison of the number of hospital visits during the lockdown with the number of hospital visits during the same months in 2019 could have better represented the decrease in patient footfalls because of the pandemic. Majority of the patients from Bihar travel to other states for cancer treatment, but because of the lockdown and the resultant travel restrictions, they were forced to continue their treatment at centers closer to their places of residence. Many of these patients must have approached the regional cancer center for continuation of their treatment. This is an important point to be stressed, and one that will help us to understand the level of trust in the local cancer care facilities.

Details related to the number of new cases registered during the pandemic, number of patients who completed chemotherapy, and number of patients receiving chemotherapy in view of the unavailability of radiation or surgical services have not been reported. In addition, the authors have not reported the number of patients who were newly diagnosed with cancer and the number referred from different departments. This could help in understanding the real impact of the pandemic on cancer care delivery in a regional cancer center.

The authors have also not mentioned the proportion of patients who were switched from a once-a-week to a once-in-3-weeks chemotherapy regimen, as this is an important measure adopted by several cancer centers to prevent the spread of COVID-19. Data related to oncologists' prescription or the patients' choice in deciding the type of chemotherapy regimen has also not been reported.

Many patients with cancer might have required hospitalization to manage the side effects of chemotherapy; this aspect has not been discussed in the study. This was a retrospective audit with missing demographic details and was therefore limited in its ability to draw a conclusion. The authors have cited a tweet from the twitter handle of the Bihar Health Department, but this is not generally encouraged in scientific writing.

This pandemic has increased our awareness about the shortcomings of the cancer care delivery system in the rural areas. It is expected that there will be an increase in the number of new cases diagnosed at an advanced stage,[15] increasing the patient load in the months to come.[16] We must prepare ourselves to ensure that every patient with cancer has access to cancer care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shankar A, Saini D, Roy S, Mosavi Jarrahi A, Chakraborty A, Bharti SJ, et al. Cancer care delivery challenges amidst coronavirus disease - 19 (COVID-19) outbreak: Specific precautions for cancer patients and cancer care providers to prevent spread. Asian Pac J Cancer Prev 2020;21:569-73.  Back to cited text no. 1
    
2.
Pramesh CS, Badwe RA. Cancer management in India during Covid-19. N Engl J Med 2020;382:e61.  Back to cited text no. 2
    
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8.
Babu TA, Sharmila V. COVID-19 pandemic: Another nail in the coffin of the “dying art” of the physical examination. Cancer Res Stat Treat 2020;3:610.  Back to cited text no. 8
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9.
Dhumal SB, Noronha V, Kurup AR, Patil V, Joshi A, Menon N, et al. Palliative oral triple metronomic chemotherapy in a patient with head-and-neck cancer during the COVID-19 pandemic in India: A case report. Cancer Res Stat Treat 2020;3:608-9.  Back to cited text no. 9
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Sinha S, Laskar SG, Mummudi N, Budrukkar A, Swain M, Agarwal JP. Head-and-neck cancer radiotherapy recommendations during the COVID-19 pandemic: Adaptations from the Indian subcontinent. Cancer Res Stat Treat 2020;3:424-6.  Back to cited text no. 10
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Menon N, Noronha V, Joshi A, Patil V, Prabhash K. Systemic therapy for thoracic malignancies during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:29-34.  Back to cited text no. 11
    
12.
Patil V, Noronha V, Chaturvedi P, Talapatra K, Joshi A, Menon N, et al. COVID-19 and head and neck cancer treatment. Cancer Res Stat Treat 2020;3 Suppl S1:15-28.  Back to cited text no. 12
    
13.
Pandey A, Rani M, Chandra N, Pandey M, Singh R, Monalisa K, et al. Impact of the coronavirus disease 2019 pandemic on cancer care delivery: A single-center retrospective study. Cancer Res Stat Treat 2020;3:683-91.  Back to cited text no. 13
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14.
Ghosh J, Ganguly S. Decline in the number of patients with cancer during the COVID-19 pandemic: A matter of concern or just a statistic? Cancer Res Stat Treat 2020;3:793-5.  Back to cited text no. 14
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Selvaraj VK, Gudipudi DK. Surge in pelvic and para aortic nodal involvement in newly diagnosed cervical cancer patients during coronavirus disease 2019: A chance or imminent reality? Cancer Res Stat Treat 2020;3:829-30.  Back to cited text no. 15
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16.
Shankar A, Saini D, Kundal R, Goyal N, Roy S, Angural H, et al. Cancer care delivery challenges in India during the COVID-19 era: Are we prepared for the postpandemic shock? Asia Pac J Oncol Nurs 2021;8:1-4.  Back to cited text no. 16
  [Full text]  




 

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